Household income, parental education impact health intervention effects for preschoolers
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Key takeaways:
- A preschool-based health intervention was less effective for children of lower socioeconomic status.
- Most children showed improvements in knowledge, attitudes and habits regarding healthy choices.
Preschool-aged children of lower socioeconomic status have poorer health and derive less benefit from the same lifestyle interventions delivered to preschoolers of higher socioeconomic status, according to study findings.
In a new analysis of the FAMILIA Project, a multinational effort to intervene early in the lives of children, researchers found that all children who participated in a specialized curriculum that emphasized heart-healthy behaviors showed improved knowledge, attitudes and habits about nutrition and physical activity; however, there were differences in the level of benefit by household income and parental education level.
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“What you teach to children between the ages of 3 and 6 or 7 years gets embedded into them and is seen when they are adults,” Valentin Fuster, MD, PhD, president of Mount Sinai Heart and physician-in-chief of The Mount Sinai Hospital, who created and led the FAMILIA Project, told Healio. “We need to present health as a priority at this young age.”
For the new analysis, Fuster and colleagues analyzed data from 3,839 preschool-aged children participating in the Si! Program, conducted in Bogotá, Colombia (n = 1,216; mean age, 3.5 years; 47% girls), Madrid (n = 2,061; mean age, 4.2 years; 49.5% girls) and Harlem, New York (n = 562; mean age, 4.1 years; 51.1% girls).
At baseline, children underwent weight and height measurements and answered a simple guided questionnaire, which included pictures for easier comprehension, to test their knowledge, attitudes and behaviors regarding diet, physical activity, how the human body and heart works, and emotions. Children assigned to the intervention went through a learning program created by cardiologists, psychologists and educators with specialized classwork, Fuster said.
“For approximately half of the children, we taught them about health,” Fuster said in an interview. “First, how the body works; second, the best approaches to appropriate nutrition; third, the importance of physical activity; fourth, how to control emotions and teach how to avoid alcohol, tobacco and other drugs in the future. This lasted for 60 hours over 6 months. The other half of the children served as controls.”
Researchers assessed the effect of household income and parental education level (both self-reported by parents and caregivers) on the difference between the intervention and control groups in change from baseline to immediately after the intervention in measures of knowledge, attitudes and habits. Researchers also measured BMI z scores at baseline and after intervention.
The findings were published in a research letter in the Journal of the American College of Cardiology.
The median follow-up time was 6.7 months; overall adjusted baseline knowledge, attitudes and habits score was 46.3 points (range, 0-80; 95% CI, 46-46.7).
At baseline, researchers found that children with higher parental education displayed higher knowledge, attitudes and habits scores compared with children of parents with low education (mean, 47.2 vs. 45.7). Similarly, children from families with higher household income had higher scores vs. children from families with lower household incomes (mean, 47.4 vs. 45.8).
The mean difference between intervention groups in knowledge, attitudes and habits change from baseline to immediately after the intervention was 4.76 points (95% CI, 2.78-6.74). The effect of the intervention on knowledge, attitudes and habits change displayed a trend toward larger differences for children from families with high household income and intermediate/high parental education level. The overall mean difference in BMI z score change between groups was –0.06 (95% CI, –0.14 to 0.02) with no significant differences by socioeconomic status, according to the researchers.
“This showed that across the three socioeconomic status and education groups, the children in the intervention did better in attitude, knowledge and habits vs. the controls,” Fuster told Healio. “Then, looking at these three regions, there are differences. Among those who were from families with lower income or education levels, they did well but not as well as those from higher-income or education level families, for example, comparing Harlem with Madrid. But I want to emphasize that, regardless of the region, the intervention demonstrated significant benefit by teaching these children about health with this format.”
Fuster said the data show more work is needed to develop an intervention that is meaningful for children regardless of socioeconomic background. That work continues today.
"This [analysis] included 4,000 children. We are now working with 50,000 children around the world," Fuster told Healio. "Instruction and education at a young age, regardless of the income level or education level of the family, has a significant impact in these children. However, we probably need to re-intervene every 3 to 5 years and then the benefits are likely exponentially better. Another aspect is the role of the environment. Among children who serve as controls, living in an environment where health is addressed did much better than expected.”
Fuster and colleagues are now running the school program in New York City and plan to expand it across all five boroughs. The expanded version will evaluate other factors, such as teacher’s motivation, environment (pollution) and familial issues.
“We are now also looking at families across generations, with the same format of intervention,” Fuster told Healio.
For more information:
Valentin Fuster, MD, PhD, can be reached at valentin.fuster@mountsinai.org.
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